A Live Baby or Your Money Back

Parenting is among the most basic of human instincts. Clinics that market in-vitro fertilization procedures to childless couples know this well. Several fertility clinics around the U.S. these days aggressively tout such procedures, generally offering couples two options. The first is an a la carte program in which couples pay $7,500 per attempt at having a so-called test-tube baby. Alternatively, clinics offer a money-back guarantee. Couples pay $15,000 up front for three attemptsand if these fail, they get a full refund.

The study shows, expectedly, that from the patients’ perspective, the choice is a no-brainer: Couples eager to have a child would clearly be better off choosing the money-back option. From the clinics’ point of view, however, this option is harder to explain. Chances of an in-vitro fertilization attempt resulting in a live birth are roughly one in five. In addition, the cost to the clinic per attempt is fairly high. Why, then, would clinics offer patients a money-back guarantee, when this is almost certain to result in the clinics’ losing money?

Schmittlein explains the reason is that aggressive marketing of money-back guarantees in the media has brought about a change in the behavior of infertile couples. In the past, childless couples tended to view in-vitro fertilizationa procedure usually not covered by health insuranceas their last resort. But now, for couples reassured by money-back guarantees, "in-vitro procedures are becoming the first choice," Schmittlein says. As a result, younger and relatively less infertile couples have been choosing in-vitro fertilization. As they do this relatively early in their attempts to have a child, clinics get a steady stream of business.

Schmittlein points out that while neither clinicswho profit from these proceduresnor patientswho get a baby or a refundare likely to complain about this situation, it has serious public policy ramifications. Patients should be made aware of the risks of in-vitro fertilization procedures, such as the possibility of multiple births. Some studies also suggest a link between in-vitro fertilization and ovarian cancer. If couples were more fully informed, he adds, they might well choose less invasive procedures than in-vitro fertilization, especially in the early stages of their attempts at parenthood.

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